New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Am J Clin Nutr. 2022 Jan 11;115(1):154-162. doi: 10.1093/ajcn/nqab287.
BACKGROUND: Carbohydrate restriction shows promise for diabetes, but concerns regarding high saturated fat content of low-carbohydrate diets limit widespread adoption. OBJECTIVES: This preplanned ancillary study aimed to determine how diets varying widely in carbohydrate and saturated fat affect cardiovascular disease (CVD) risk factors during weight-loss maintenance. METHODS: After 10-14% weight loss on a run-in diet, 164 participants (70% female; BMI = 32.4 ± 4.8 kg/m2) were randomly assigned to 3 weight-loss maintenance diets for 20 wk. The prepared diets contained 20% protein and differed 3-fold in carbohydrate (Carb) and saturated fat as a proportion of energy (Low-Carb: 20% carbohydrate, 21% saturated fat; Moderate-Carb: 40%, 14%; High-Carb: 60%, 7%). Fasting plasma samples were collected prerandomization and at 20 wk. Lipoprotein insulin resistance (LPIR) score was calculated from triglyceride-rich, high-density, and low-density lipoprotein particle (TRL-P, HDL-P, LDL-P) sizes and subfraction concentrations (large/very large TRL-P, large HDL-P, small LDL-P). Other outcomes included lipoprotein(a), triglycerides, HDL cholesterol, LDL cholesterol, adiponectin, and inflammatory markers. Repeated measures ANOVA was used for intention-to-treat analysis. RESULTS: Retention was 90%. Mean change in LPIR (scale 0-100) differed by diet in a dose-dependent fashion: Low-Carb (-5.3; 95% CI: -9.2, -1.5), Moderate-Carb (-0.02; 95% CI: -4.1, 4.1), High-Carb (3.6; 95% CI: -0.6, 7.7), P = 0.009. Low-Carb also favorably affected lipoprotein(a) [-14.7% (95% CI: -19.5, -9.5), -2.1 (95% CI: -8.2, 4.3), and 0.2 (95% CI: -6.0, 6.8), respectively; P = 0.0005], triglycerides, HDL cholesterol, large/very large TRL-P, large HDL-P, and adiponectin. LDL cholesterol, LDL-P, and inflammatory markers did not differ by diet. CONCLUSIONS: A low-carbohydrate diet, high in saturated fat, improved insulin-resistant dyslipoproteinemia and lipoprotein(a), without adverse effect on LDL cholesterol. Carbohydrate restriction might lower CVD risk independently of body weight, a possibility that warrants study in major multicentered trials powered on hard outcomes. The registry is available through ClinicialTrials.gov: https://clinicaltrials.gov/ct2/show/NCT02068885.
背景：碳水化合物限制对糖尿病有希望，但由于低碳水化合物饮食中饱和脂肪含量高，限制了其广泛应用。
目的：本预先计划的辅助研究旨在确定在减肥维持期，碳水化合物和饱和脂肪含量差异很大的饮食如何影响心血管疾病（CVD）风险因素。
方法：在进行 10-14%的体重减轻的初始饮食后，164 名参与者（70%为女性；BMI=32.4±4.8kg/m2）被随机分配到 3 种减肥维持饮食，持续 20 周。准备的饮食含有 20%的蛋白质，能量的碳水化合物（Carb）和饱和脂肪比例相差 3 倍（低碳水化合物：20%碳水化合物，21%饱和脂肪；中碳水化合物：40%，14%；高碳水化合物：60%，7%）。在随机分组前和 20 周时采集空腹血浆样本。脂蛋白胰岛素抵抗（LPIR）评分根据甘油三酯丰富、高密度和低密度脂蛋白颗粒（TRL-P、HDL-P、LDL-P）大小和亚组分浓度（大/超大 TRL-P、大 HDL-P、小 LDL-P）计算。其他结果包括脂蛋白（a）、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、脂联素和炎症标志物。采用重复测量方差分析进行意向治疗分析。
结果：保留率为 90%。LPIR（0-100 级）的平均变化按饮食呈剂量依赖性方式不同：低碳水化合物（-5.3；95%CI：-9.2，-1.5）、中碳水化合物（-0.02；95%CI：-4.1，4.1）、高碳水化合物（3.6；95%CI：-0.6，7.7），P=0.009。低碳水化合物还可改善脂蛋白（a）[-14.7%（95%CI：-19.5，-9.5）、-2.1%（95%CI：-8.2，4.3）和 0.2%（95%CI：-6.0，6.8），P=0.0005]、甘油三酯、高密度脂蛋白胆固醇、大/超大 TRL-P、大 HDL-P 和脂联素。LDL 胆固醇、LDL-P 和炎症标志物不受饮食影响。
结论：一种富含饱和脂肪的低碳水化合物饮食改善了胰岛素抵抗性血脂异常和脂蛋白（a），而对 LDL 胆固醇没有不良影响。碳水化合物限制可能独立于体重降低 CVD 风险，这一可能性值得在以主要终点为目标的大型多中心试验中进行研究。该注册信息可通过 ClinicialTrials.gov 获得：https://clinicaltrials.gov/ct2/show/NCT02068885。
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